Care Home: Field View national Autistic Society

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What the care home does well The home has an enthusiastic team of people working within the service, who like doing their jobs and learning more about how to do it well. The staff team want to make sure that the people who live in the home receive good care. Staff showed a good understanding of what each individual likes and dislikes and we saw staff use a number of techniques for communicating with the people using the service. People being cared for have good access to professional medical staff and are able to access external services such as dentists, specialist nurses, GP`s and consultants, so their health is looked after and they are kept well. What has improved since the last inspection? This is the first visit to a brand new service, so no previous reports exist. What the care home could do better: Information in the care plans need be looked at and rewritten to become more person centred and make sure people using the service get personalised care. The Controlled Drugs Register completed by the staff needs to be more accurate and up to date, to ensure the health and wellbeing of people using the service is protected and promoted. The grounds around the home need landscaping so that the grassed areas are level and safe for people to walk or run on, without risk of them falling. There must be a good system in place for listening to what people and relatives say about the home and acting on this information to make the service better for those people who use it. We would like to thank everyone who completed a survey or spoke to us during this visit. Your comments are very important to us and ensure this report includes the views of people who use the service or work within it. Key inspection report Care homes for adults (18-65 years) Name: Address: Field View national Autistic Society Field View Station Road Yorkshire DN14 8QP     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Eileen Engelmann     Date: 2 8 0 9 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 34 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 34 Information about the care home Name of care home: Address: Field View national Autistic Society Field View Station Road Yorkshire DN14 8QP 0 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): National Autistic Society Name of registered manager (if applicable) Miss Rebecca Nicholls Type of registration: Number of places registered: care home 8 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability mental disorder, excluding learning disability or dementia Additional conditions: The Maximum number of service users who can be accommodated is : 8 The registered person may provide the following category of service only Care home only - Code PC To service users of the following gender - Either whose primary care needs on admission to the home are within the following categories Learning Disabilities Code (LD) Date of last inspection Brief description of the care home Field View is a purpose built facility, which provides accommodation for up to 8 individuals who have Autism. The home is situated in the village of Rawcliffe, near the town of Goole. There is ample parking on site for visitors and staff and a local bus route passes by the home. There are rail links in the town of Goole and the home is about a 10 minute drive from the M62 motorway. The home is split into three accommodation areas, which are designed to offer different types of living space to Care Homes for Adults (18-65 years) Page 4 of 34 Over 65 0 0 8 0 Brief description of the care home those who use the service. Four people have their own single, en-suite bedrooms and share a communal lounge, dining room and kitchen. Two people have their own flatlets with a kitchenette, open plan lounge/dining area, bedroom and en-suite bathroom; they also have patio doors leading onto their own enclosed garden space. Two people have independent flats with fully functioning kichen and laundry facilities, open plan lounge/dining area, bedroom and en-suite bathroom. These flats also have their own garden areas. At the time of our visit on 28 September 2009 the manager told us the fees were from 2195.00 GBP to 4312.00 GBP a week depending on the amount of care required by each individual. Care Homes for Adults (18-65 years) Page 5 of 34 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: Information has been gathered from a number of different sources over the past 6 months since Field View was registered with the Care Quality Commission, this has been analysed and used with information from this visit to reach the outcomes of this report. This unannounced visit took place with the manager, staff and people using the service. The visit included a tour of the premises, examination of staff and peoples files, and records relating to the service. Staff interactions with people using the service were positive with staff talking and interacting readily with individuals. People were relaxed in their home and appeared comfortable. Due to the specific communication needs of the majority of the people using the service, no formal discussions were held between them and the inspector. We telephoned four parents who wished to talk about their relatives care in the home, we Care Homes for Adults (18-65 years) Page 6 of 34 visited one person using the service who has their own flat on the site and had an informal chat with them, met and chatted to three other service users and spoke briefly to staff who were on duty during our visit. Peoples comments have been included in this report. Questionnaires were sent out to a selection of people living in the home, relatives and staff. Their written response to these was good. We received 4 from staff (80 ), 3 from relatives (60 ) and 1 from people using the service (50 ). The manager completed an Annual Quality Assurance Assessment and returned this to us within the given timescale. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations - but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. Care Homes for Adults (18-65 years) Page 7 of 34 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 34 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 34 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People undergo a full needs assessment and are given sufficient information about the home and its facilities prior to admission, to enable them to be confident that their needs can be met by the service. Evidence: Three peoples care and records were looked at as part of this visit, they each have been provided with a statement of terms and conditions/contract on admission and these are signed by the person or their representative. These documents give clear information about fees and extra charges in a clear print and pictoral format, that is meaningful and appropriate for the people using the service. In each of the three care plans looked at during this visit there was a copy of the community care assessment/Local Authority care plan. The home also completes their assessment of need and input from other professionals and/or family is also recorded; from these a detailed care plan is developed. Information given to us in the Annual Quality Assurance Assessment (18/9/09) and Care Homes for Adults (18-65 years) Page 10 of 34 Evidence: through discussion with the manager is that wherever possible individuals thinking about moving into the home, are encouraged to visit the service on several occasions to meet the staff and other people living in the home, before making the decision to come in permanently. Where a person is unable to visit the home the manager or senior staff will meet with them before they are admitted so they see a familiar face when they come into the service. Care Homes for Adults (18-65 years) Page 11 of 34 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health, personal and social care needs of the people living in the home are being met by the service and staff, and people using the service have confidence in the staff looking after them. Evidence: Information given to us in the relatives surveys, and during discussions on this visit with people using the service, indicates that individuals are satisfied with the care provided by the service, and those using the service enjoy life in the home. Comments from the surveys said we are very impressed with the care our son is receiving and delighted with the efforts made to meet his needs in the new environment and the service appears to be observing our son and adjusting his care plan accordingly. One relative who spoke to us on the telephone said I am delighted with the care being given to my son, he is happy and content in the home. The staff are lovely and keep me informed about my sons wellbeing. The care of three people was looked at in depth during this visit and included checking Care Homes for Adults (18-65 years) Page 12 of 34 Evidence: of their personal care plans. Each individual using the service has a detailed care plan, which identifies each persons needs and the action staff must take to meet these. In addition to this information there are risk assessments to cover daily activities of life, behaviour management plans where a risk to the person or others has been identified, and clear information about health and input from professionals and the outcomes for people. Reviews of care with the families, person living in the home and care coordinator from the local authority are taking place and minutes of these meetings are in the plans. We found that there were some aspects of the care plans that could be improved and these were as follows:The care plans contain a lot of information about each individual, but this information could be presented in a much more person centred way within the plans. How this could be achieved was demonstrated in the care plan of one individual, who has a This is about me booklet, which was produced by the local council. Information in this booklet is presented in a large print, and uses pictures and photgraphs to give a very personalised view of the individuals life. We recommended that the manager ensures care plans are reviewed and become more personalised by the end of December 2009. There is no seperate medical sections to the care plans that could be taken with the person if they are admitted to hospital; we discussed with the manager how these could contain up to date information about individuals and ensure that important information is passed to relevant health professionals involved in diagnosis and treatment of people using the service. We recommend that the manager considers developing this aspect of the plans. Some of the information in the care plans is out of date, one person has now finished school and is moving onto college, but his care plan has not been updated. The manager assured us that this would be done as soon as possible. There is limited information about family/friend contact within the care plans; we recommended that this aspect of the care plans is developed further. In response to the Mental Capacity Act and Deprivation of Liberty legislation, the home has requested an assessment for one person living in the home around restricting access to the communal gardens when the individual is being aggressive. This is being considered by the appropriate authorities. One person in the home has an appointed advocate, another is being referred to the advocacy service, and the home is looking into the possibility of getting a befriender for a third person. Families are being invited to attend a Family Liasion meeting in October 2009, this it to enable individuals to voice any concerns or issues they may have around care or the service. Care Homes for Adults (18-65 years) Page 13 of 34 Evidence: It is hoped that these will be held on a two to three monthly basis. Staff enable people to take responsible risks in their every day lives and information within the care plans includes a number of risk assessments covering activities of daily living, use of equipment and personal safety information. Staff have had training around equality and diversity, Deprivation of Liberty, Mental Capacity Act and Safeguarding of Adults. This knowledge and information is used to ensure that peoples choices and human rights are maintained and that any limitations on facilities or personal choice are only made following assessment, best interest meetings, risk assessments and discussion with the person concerned or their representative. Care Homes for Adults (18-65 years) Page 14 of 34 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service are given the opportunity to take part in a variety of activities both within the home and in the community. They can access and enjoy opportunities in their local community such as public transport, library services and the local shops. Evidence: At the time of our visit (September 2009) there was one person accessing full time education and two people who attend an Arts and Crafts course at Goole College for four hours a week. The home has two cars for transporting people in and around the community and staff undergo robust tests before they can drive these vehicles. Recent trips out include visits to the sea-side, a Safari Park, York, Doncaster and Pontefract. There is a local bus route, which stops outside of the home and people living in the home are able to go with staff to the nearby towns of Selby and Goole to shop and participate in leisure activities. Care Homes for Adults (18-65 years) Page 15 of 34 Evidence: The manager told us that the activity worker hours have been put into the staffing rota to enable more flexibility around outings and time spent on social events. Individuals each have their own activity schedule in their care plans, which detail their interests and hobbies. We spoke to one individual who enjoys having a cigarette in his own garden, plays the piano, enjoys shopping and going to the local library. Another individual whose care plan we looked at enjoys gardening and walking, participates in Arts and Crafts and likes travelling on the local buses and in the homes car. Comments from the relative surveys indicate that parents are noticing a positive difference in their relatives behaviour. One person said our son is a lot calmer now when he comes home and this helps him access more activities, and another told us that our son is regaining skills which he had lost over the years while in inappropriate provision. It gives us confidence and hope for the future. Walking around the home we observed staff spending 1-1 time with individuals; people were out and about in the gardens, spending time in their rooms with favourite possessions, doing games and activities in the lounge or enjoying time alone in their flats. Regular activities include walks in the community and attending the Splashers club (swimming for disabled individuals) held in the local leisure centre. The manager told us that she is busy trying to source more funding so people can take part in a lot more community activities, but this is a slow process. Information gathered from our telephone conversations with parents and our relatives survey questionnaires, indicates that some people are satisfied with the level of contact they have with the home about their relatives care and others are not. One person told us we have issues with the effectiveness of the communication between the home and ourselves. We need to contact Field View for updates even though we have requested regular weekly feedback, and we feel that they need two phone lines as we have constantly rung and it goes onto the fax machine. If we had an emergency this is a vital concern. We spoke to the manager about these concerns and she told us that she is waiting for another telephone to be put into the upstairs office, and that the telephone in use is not put onto the fax machine. However, during the afternoon of our visit it was found that the telephone had been switched to the fax machine. Another relative who spoke to us was delighted with the communication between the home and the family. They said that they were kept up to date with any issues around care and were able to ring at any time and staff would talk to them about their Care Homes for Adults (18-65 years) Page 16 of 34 Evidence: relative. The home has recognised that there are some teething problems with the service and has arranged a meeting for families in October 2009 to discuss issues and these meetings are to be held on a regular basis. The National Autistic Society sends out a monthly newsletter for the Yorkshire and Humber region, and plans to set up a website which would be a little like facebook. The website would only be for the Autistic Society and anyone using it would need a license for access. Each person using the website would have limited access to their particular relatives details only. This is hoped to be set up by December 2009. The one person we spoke to is very happy with the way that staff look after them, they felt that they are given choices in their everyday life and staff respected their privacy and dignity. Observations of the interaction between staff and people showed that there is a good relationship between the two groups based on trust and friendship. Bedroom doors are supplied with simple locks and the staff respect the fact that people need time alone or with their family. There are few individuals using the service who can verbally communicate their wishes to people, so a variety of aids are used to enable better communication between staff and people. We saw that some individuals have now and next boards in their rooms to show them what is happening during their day. Others use PECs, verbal sounds and gestures, Makaton and picture boards. All staff go through a six week induction which includes SPELL training, this focuses on Autism and the complex needs of people who have this condition, this helps staff understand and meet the needs of the people using the service. Meal times at Field View are very relaxed and people can eat when and where they wish. The main meal of the day is in the evening and this is the only time that individuals are expected to sit down and eat together. The main meal is from a set menu, but during the day people can choose what they want to eat by using pictures to indicate their choices or visiting the pantry and showing staff what they want. People living in the home only go into the main kitchen under staff supervision and two individuals are able to make their own sandwiches, drinks or snacks with staff help. Everyone has their own tuck box in the pantry containing their favourite foods such Care Homes for Adults (18-65 years) Page 17 of 34 Evidence: as crisps, drinks and sweets. We observed a number of individuals eating at lunchtime, there were a variety of foods on offer such as pasta, sausage rolls, sandwiches, fresh fruit and yoghurts. Care Homes for Adults (18-65 years) Page 18 of 34 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples personal and healthcare needs are met through good inter-agency working and by the staff having a sound knowledge of each individuals needs. Staff ensure that personal support is flexible, consistent and is able to meet the changing needs of the people using the service. Evidence: It was apparent from discussions with the staff that they were knowledgeable about peoples preferences and likes/dislikes regarding their care. Information, within the care plans looked at, shows that each person has their own preferred daily routine including their choices and wishes regarding care giving. Staff informed us about certain actions that could upset or agitate people using the service, to ensure that our visit did not unduly cause any problems to those living in the home. Information in the care plans and discussion with the manager indicated that the service encourages individuals to develop their skills in carrying out personal hygiene. Staff offer help and support with teeth brushing, bathing, washing, dressing and toileting, but give individuals time to try this for themselves (where able). Comments from our relative surveys and telephone conversations with parents indicate that there Care Homes for Adults (18-65 years) Page 19 of 34 Evidence: were some concerns from parents about how effective the hygiene routines were in the home. Relatives told us we are concerned about our sons hygiene as in bathing and brushing of teeth. We understand he has to try to do things himself but needs help to finish the tasks, and there was a slow response to provide certain aspects of personal care such as bathing of hair, nails and dental care. The manager told us she was aware of the concerns of the relatives and hoped to discuss these further at the Family Meeting in October 2009. All of the people we met during this visit were well presented, clean and clearly happy in their surroundings. People in the home are able to access health care through the local GP, mental health team, epilepsy specialist nurse and dentist amongst others who provide support and advice for the staff when needed. Staff have attended training around epilepsy awareness to help them meet the needs of people using the service. Information in the care plans shows that individuals are receiving visits from health care professionals and support plans are in place to deal with their medical conditions. Everyone using the service has received a home visit from the local NHS dentist, individuals are registered with the local health care centre, three people have visits from the Community Psychatric Nurse and one person has visits from the Mental Health Team. One person sees the epilepsy specialist nurse and two other people have been referred to this service. Input is also received from two consultants, one for psychiatry and one for epilepsy. The home uses a local pharmacy to provide the medicines to people using the service. There are information sheets in the medication records telling staff about the different types of medication in use and further advice on how each individual person likes to take their medication. Checks of the medication records showed that these are up to date and completed to an acceptable standard. One recommendation we made was that where staff are carrying medication over from one medication record sheet to another then there should be a record of the balance of medicines being brought forward. We looked at the Controlled Drugs in the home and checked these against the Controlled Drugs register maintained by the staff. The Controlled Drugs in stock had not been used, as they were mainly for medical emergencies, but how they had been recorded in the register was incorrect. Discussion with the manager indicated that staff had not received training from the pharmacist about how to complete the Care Homes for Adults (18-65 years) Page 20 of 34 Evidence: register. We recommended that this training was put into place as soon as possible. Care Homes for Adults (18-65 years) Page 21 of 34 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a satisfactory complaints system with some evidence that peoples views are listened to and acted upon. Evidence: The home has a complaints policy and procedure, which can be found in the Service User Guide kept in the care plans. As the majority of people using the service are unable to comprehend written information, the staff talk to individuals on a daily basis and ask if they have any problems. One person who can communicate verbally is encouraged to talk to the manager about any issues they may have. The majority of people living in the home have parents who will act on their behalf, others have external advocates who would help them. As a new service the manager is aware that there will be a number of teething problems that will need discussing with individuals, and as the people using the service settle into the home the staff will get to know them better and adapt their care to meet their changing needs. In order to address peoples concerns, niggles and grumbles the manager is holding a Family Meeting every two to three months, as a forum where people can discuss their issues and hopefully find a resolution. In addition to the meetings the home uses contact sheets, a telephone message book and a comments book to record any niggles and grumbles, and the manager deals with these as they arise. Care Homes for Adults (18-65 years) Page 22 of 34 Evidence: Discussion with the manager indicated that she and some of the staff have attended Safeguarding of Adults from Abuse training and the rest of the staff are booked to complete this in October 2009. All staff undergo a six week induction programme when they start work, this includes SPELL training which looks at Autism and has a number of different units for staff to work through. Studio 3 training is delivered by external trainers and is also centred around the complex needs of people with Autism and how to manage their challenging behaviours. The home tries hard not to use restraint techniques, but sometimes due to peoples behaviour it is needed to keep the individual and others safe. The Studio 3 trainers show staff how to avoid confrontations where possible, but also instructs them in what to do if a situation escalates. The manager informed us that the trainers will be re-visiting the home soon, to observe two individuals and then work with the staff to develop appropriate approaches and strategies to manage the challenging behaviour of the individuals. Care Homes for Adults (18-65 years) Page 23 of 34 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The environment provides people with safe, comfortable and homely surroundings in which to live, that meet their individual needs and lifestyles. Evidence: Field View is a purpose built facility, consisting of a large bungalow and two flats in a seperate building. There is a large car park to the front of the building for visitors and staff, and open grounds around the home with fenced boundaries. Comments from the relatives surveys indicates that a number of parents have concerns about the safety of the grounds. One relative said the maintenance of the grounds needs seeing to, as when you visit it is not very appealing from the outside. The inner grassed area needs landscaping as it is unsafe for people living in the home to walk or run on. One relative told us it is essential the grounds are maintained and made available throughout the year, as they make an important contribution to client welfare. Our son finds it very cathartic to walk outside. The manager told us that contractors have been in to tidy up the boundaries and grass areas, but there is a need for further ground work to ensure the uneven levels of the grassed areas are dealt with. The front door of the building is kept locked at all times, staff can access this using Care Homes for Adults (18-65 years) Page 24 of 34 Evidence: wrist bands which open all locked doors within the building. Visitors are asked to ring the bell and staff will open the doors. Staff use a video entry system for security at night. Internal doors are locked, and visitors or people living in the home can open these using push buttons on the walls. There are gates to the home and these are locked at night, however some parents expressed concerns that people living in the home could walk out of the home and into the community without staff during the day time. The manager is aware of these concerns and is hoping to discuss this further at the Family Meeting in October 2009. Field View is able to offer people a choice of three different types of accommodation. In the main bungalow there is shared accommodation for four people and two flatlets, and away from the main building are two independent flats. Each bedroom in the home has an individual thermostat so people can set their own room temperature, and rooms are fitted with dimmer switches for the lighting. The home has underfloor heating so there are no radiators to create a risk to people using the service In the shared accommodation there are four single bedrooms, each provided with an en-suite shower/bathroom and toilet facilities. People living in this area share a large living room and dining area, have a smaller lounge and supervised access to a large kitchen. The main laundry service is in this area with washing, drying and sluicing facilities, and there is a communal bathroom. The two flatlets have en-suite single bedrooms, a kitchenette with snack and drink making facilities, an open plan lounge/dining area and patio doors leading onto personal enclosed garden space. Individuals staying in the flatlets have access to the main gardens via a gate and can access the communal living space in the bungalow. The two independent flats have fitted, fully functioning kitchen and laundry facilities, an open plan lounge/dining room, en-suite single bedrooms and patio doors leading onto their own garden areas. In the main part of the home there is a sensory room for use by all individuals, and an office with lockable storage for records and medication cabinets. On the upper floor staff have a sleepover room and there is a seperate meeting room for staff and resident formal meetings. The laundry facility in the main part of the home is run by the care staff, they do the laundry although people using the service can help if willing and able. Those living in the flats have their own washing machines and staff assist these individuals to do their own laundry. Care staff have attended Infection Control Training and have access to Care Homes for Adults (18-65 years) Page 25 of 34 Evidence: aprons and gloves when doing laundry or personal care. Care Homes for Adults (18-65 years) Page 26 of 34 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staff induction, training and recruitment practices are good, resulting in an enthusiastic workforce that works positively with people to improve their whole quality of life. Evidence: At the time of our visit there were seven male residents in the home and out of the nineteen members of staff, six are male care staff. So individuals have a choice of who looks after them. Comments from the relatives were positive about the staff, one person said the staff who look after our son are exceptionally good, caring, perceptive and enthusiastic individuals who share our pleasure in his progress. Another relative told us we believe the staff are excellent, our son has settled in better than expected and that is due to the efforts of the staff. Checks of the staffing rotas show that during the day there are six care staff on duty and at night there are three waking night staff. However from November 2009 the night staff are changing to two waking and one sleeping. Some individuals require more 1-1 or 2-1 support and the notice board in the office shows staff who is working with which person each day. Occassionally the home uses agency staff and care is taken to ensure the same staff are used on a regular basis, so people living in the service get to know the staff and are comfortable around them. Using information Care Homes for Adults (18-65 years) Page 27 of 34 Evidence: about dependency levels provided by the manager at the this visit, checks against the residential staffing forum guidelines for a younger adults home shows that the home is meeting the minimum recommended staffing hours. The home has an equal opportunities policy and procedure. Information from the staff personnel and training records and discussion with the manager, shows that that this is promoted when employing new staff and throughout the working practices of the home. The home has a recruitment policy and procedure that the manager understands and uses when taking on new members of staff. Checks of three staff files showed that police (CRB) checks, written references, health checks and past work history are all obtained and satisfactory before the person starts work. All new members of staff undergo a six week induction, Week 1 covers SPELL training, health and safety and a corporate induction. Week 2 staff attend Safeguarding of Adults from Abuse training, Week 3 staff cover person centred approach training, Week 4 is Management of Challenging Behaviour, Week 5 is SPELL 2 training and Week 6 covers health and safety, first aid and food safety. There is a rolling programme of mandatory safe working practice training and additional specialist subjects linked to the complex needs of those with Autism. Over 50 of the care staff have achieved an NVQ 2 qualification in care and the rest of the staff were registered on the training programme in September 2009. Staff are going on to achieve NVQ 3 (4 have completed this) and 2 staff are doing NVQ 4. Care Homes for Adults (18-65 years) Page 28 of 34 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager is supported well by senior staff in providing clear leadership throughout the home, with all staff demonstrating an awareness of their roles and responsibilities. Evidence: The registered manager of the service is Rebecca Nicholls and she has been in post since the home opened in 2009. She has previous experience of working for the National Autistic Society and has prior management experience in looking after those with a learning disability. At the moment Rebecca is doing an NVQ 4 in Care and the Managers and Leadership course (equivalent to Registered Managers Award), and is also completing the National Autistic Societys Management and Leadership course. The manager carries out monthly audits of the service and this includes analysis of any accidents, incidents or complaints. Copies of these audits are sent to the Head Office. The National Autistic Society carries out an internal yearly audit and the registered person visits the home each month and completes the Regulation 26 report for the service. Discussion with the manager indicated that she plans to send out satisfaction questionnaires to stakeholders on a six monthly basis, but this has yet to Care Homes for Adults (18-65 years) Page 29 of 34 Evidence: be set up. The registered person must ensure that feedback is sought from people living in the home and their relatives and that there is an annual development plan for the home, based on the systematic cycle of planning-action-review, reflecting aims and outcomes for people using the service. Maintenance certificates are in place and up to date for all the utilities and equipment within the building. Accident books are filled in appropriately and regulation 37 reports completed and sent on to the Commission where appropriate. Staff have received training in safe working practices and the manager has completed generic risk assessments for a safe environment within the home. Risk assessments were seen regarding fire and daily activities of living. Care Homes for Adults (18-65 years) Page 30 of 34 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 31 of 34 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 20 17 The registered person must ensure that the receipt, administration and disposal of controlled drugs is accurately recorded in a controlled drug register. So that the health and welfare of the people using the service is protected and promoted by the service. 01/12/2009 2 24 13 The registered person must ensure that the grounds around the home are suitable for use by the people using the service, and that the security of the grounds for the current client group is risk assessed and appropriate action taken as necessary to ensure people are kept safe. So that people and their representatives can by confident that any 01/01/2010 Care Homes for Adults (18-65 years) Page 32 of 34 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action unnecessary risks to the health or safety of people using the service are identified and so far as possible eliminated. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 6 The manager should review and update the information in the care plans to include more personalised information, a removable medical section which could be taken with the individual to appointments or hospital and a more indepth family and contacts section. The registered manager should ensure that where staff are carrying medication over from one medication record sheet to another, there is a record of the balance of medicines being brought forward kept on the current medication sheet. The manager should arrange training for staff, from the pharmacist, in how to complete the Controlled Drugs Register. The registered person should establish and maintain a system for reviewing and improving the quality of care in the home. 2 20 3 20 4 39 Care Homes for Adults (18-65 years) Page 33 of 34 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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